When Tina Hiluka of the Muliama Village in Indonesia’s Papua province gave birth to her youngest child late last year, it was a stark contrast to the births of her first four children.
Instead of at home accompanied only by her family, this time she gave birth to her baby at a public health center (Puskesmas), with the help of a trained midwife.
“They gave me water when I was thirsty, they also fed me when I was hungry,” Tina says in her local dialect. “At home, nobody really could take care of me like that.”
Just a week before she gave birth to a healthy baby boy, Tina had moved to the Puskesmas’ maternity waiting home at Assologaima sub-district, enabling her to receive this basic service. She stayed for another week to learn how best to feed and care for her young child.
Like Tina, many women in this mountainous part of the province have to walk for hours from their remote villages to the Puskesmas, discouraging them from visiting the regular antenatal check-ups during pregnancy and from seeking health services for their newborns.
Last year, a maternity honai, a Papuan traditional home made of wood and straws, has been built for them where they can stay during the last weeks of their pregnancy and after delivery. At the honai, they have immediate access to skilled birth attendance, which can provide life-saving care if medical complications arise during and after delivery. It also provides an opportunity to educate the women on good breastfeeding and caring practice for their babies.
This is a key initiative to battle the problem of undernutrition in Jayawijaya district, where a large proportion of the population lives on the mountainside without access to electricity, telecommunication, running water and transport.
Located in the Baliem Valley in Jayawijaya District, the Assologaima Health Centre serves 37,535 people living in 41 villages that dot the mountains. It is one of several Puskesmas in the district benefitting from the Maternal and Young Child Nutrition Security Initiative in Asia (MYCNSIA), a joint European Union (EU)-UNICEF programme.
The EU and UNICEF launched MYCNSIA in 2011 to improve nutrition among pregnant women and young children in Indonesia and other countries. The programme supports the government in designing and scaling up essential nutrition services for children and women. This includes strengthening the capacity of health staff and volunteers to counsel mothers on how to protect themselves and their children from undernutrition.
|Midwife Naomi Mulait weighs a baby assisted by volunteer Wemin Wetipo at the community-based health posts Air Garam At Assolokobal subdistrict in Papua.|
In Indonesia one in ten children are born with low birth weight, often because their mothers are undernourished before and during pregnancy. In 2013, almost 9 million children were stunted, or too short for their age, and almost 3 million children were wasted, or too thin for their height, because of insufficient nutrient intake and frequent infections. Undernourished children do less well at school and will be less productive as adults, which will affect their income and keep families in poverty.
The MYCNSIA programme focuses on interventions to prevent stunting during the critical first 1,000 days of life between conception and a child’s second birthday, because much of the irreversible damage is incurred during the first two years of a child’s life.
Jayawijaya is one of the three focus districts of MYCNSIA in Indonesia, aside from Klaten in Central Java and Sikka in Nusa Tenggara Timur. Jayawijaya was selected because it has some of the worst figures nationally. According to data from 2007, nearly half of all children under the age of five were stunted, while the prevalence of wasting stood at 14.6 per cent, underweight children at 22.8 per cent.
Spreading the Knowledge
At Assologaima Puskesmas midwife Regina Tabuni has trained about 30 community health volunteers, who are better known as kader, in 20 community-based health posts or Posyandu. The kader learn about healthy infant and young child feeding (IYCF) practices and maternal nutrition, and are trained on how to effectively counsel mothers. They run monthly information and education sessions on IYCF for pregnant and breastfeeding women at the Posyandus and churches, and conduct home visits to provide one-on-one counselling.
“Mothers used to get rid of the first milk or colostrum, but now they learn that it is an important source of antibodies and nutrients,” says Regina.
Exclusive breastfeeding for six months is essential to ensure healthy growth of the baby. Many women in rural Papua exclusively breastfeed for merely one or two months, and give their infants food like sweet potatoes or even pig’s fat when they are too young.
“The kader accompany the pregnant women at the maternity waiting home until they give birth. They teach them the best way of breastfeeding, and later advise on how to prepare nutritious meals for their infants when they’re ready for complementary feeding,” Regina explains. “The complementary food can come from locally grown vegetables, fruits, nuts, and yams.”
As a kader, Iria Wantik (27) from Kimbim Village makes regular house visits to pregnant women and mothers with infants in her community. She weighs them at the Posyandu to check that they’re gaining adequate weight and counsels them on nutrition and hygiene. She encourages expecting mothers to check with a midwife every two or three months and convinces late-term pregnant women to stay at the maternity waiting home.
“At church after Sunday service, I give talks to promote healthy nutrition and hygiene,” she says.
The MYCNSIA programme also involves religious leaders with some priests participating in IYCF training courses and using sermons to build the awareness of community members on harmful traditional practices.
During his recent field visit to Jayawijaya, the Head of the EU Delegation to Indonesia, Olof Skoog highlighted that, “UNICEF has implemented the project with a full understanding of the local culture, working very closely with the local midwives, cadres and religious leaders.”
UNICEF Indonesia Representative Gunilla Olsson said she was very encouraged to see how committed and engaged the kader and health workers were; the impact they were making on women’s and young children’s lives; and how basic health and maternity services had been strengthened.
“A woman who easily could have died from complications in the past because she had no access to skilled birth attendance can now give birth in a safe environment and benefit from the counselling sessions about healthy nutrition for her child,” Ms Olsson said in Jayawijaya, adding that she was encouraged to hear that the local government was committed to scaling up the program to other areas in the district.